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Welch BM, Keil AP, Buckley JP, Engel SM, James-Todd T, Zota AR, Alshawabkeh AN, Barrett ES, Bloom MS, Bush NR, Cordero JF, Dabelea D, Eskenazi B, Lanphear BP, Padmanabhan V, Sathyanarayana S, Swan SH, Aalborg J, Baird DD, Binder AM, Bradman A, Braun JM, Calafat AM, Cantonwine DE, Christenbury KE, Factor-Litvak P, Harley KG, Hauser R, Herbstman JB, Hertz-Picciotto I, Holland N, Jukic AMZ, McElrath TF, Meeker JD, Messerlian C, Michels KB, Newman RB, Nguyen RH, O’Brien KM, Rauh VA, Redmon B, Rich DQ, Rosen EM, Schmidt RJ, Sparks AE, Starling AP, Wang C, Watkins DJ, Weinberg CR, Weinberger B, Wenzel AG, Wilcox AJ, Yolton K, Zhang Y, Ferguson KK. Racial and Ethnic Disparities in Phthalate Exposure and Preterm Birth: A Pooled Study of Sixteen U.S. Cohorts. Environ Health Perspect 2023; 131:127015. [PMID: 38117586 PMCID: PMC10732302 DOI: 10.1289/ehp12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Phthalate exposures are ubiquitous during pregnancy and may contribute to racial and ethnic disparities in preterm birth. OBJECTIVES We investigated race and ethnicity in the relationship between biomarkers of phthalate exposure and preterm birth by examining: a) how hypothetical reductions in racial and ethnic disparities in phthalate metabolites might reduce the probability of preterm birth; and b) exposure-response models stratified by race and ethnicity. METHODS We pooled individual-level data on 6,045 pregnancies from 16 U.S. cohorts. We investigated covariate-adjusted differences in nine urinary phthalate metabolite concentrations by race and ethnicity [non-Hispanic White (White, 43%), non-Hispanic Black (Black, 13%), Hispanic/Latina (38%), and Asian/Pacific Islander (3%)]. Using g-computation, we estimated changes in the probability of preterm birth under hypothetical interventions to eliminate disparities in levels of urinary phthalate metabolites by proportionally lowering average concentrations in Black and Hispanic/Latina participants to be approximately equal to the averages in White participants. We also used race and ethnicity-stratified logistic regression to characterize associations between phthalate metabolites and preterm birth. RESULTS In comparison with concentrations among White participants, adjusted mean phthalate metabolite concentrations were consistently higher among Black and Hispanic/Latina participants by 23%-148% and 4%-94%, respectively. Asian/Pacific Islander participants had metabolite levels that were similar to those of White participants. Hypothetical interventions to reduce disparities in metabolite mixtures were associated with lower probabilities of preterm birth for Black [13% relative reduction; 95% confidence interval (CI): - 34 % , 8.6%] and Hispanic/Latina (9% relative reduction; 95% CI: - 19 % , 0.8%) participants. Odds ratios for preterm birth in association with phthalate metabolites demonstrated heterogeneity by race and ethnicity for two individual metabolites (mono-n-butyl and monoisobutyl phthalate), with positive associations that were larger in magnitude observed among Black or Hispanic/Latina participants. CONCLUSIONS Phthalate metabolite concentrations differed substantially by race and ethnicity. Our results show hypothetical interventions to reduce population-level racial and ethnic disparities in biomarkers of phthalate exposure could potentially reduce the probability of preterm birth. https://doi.org/10.1289/EHP12831.
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Affiliation(s)
- Barrett M. Welch
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- University of Nevada, Reno, Reno, Nevada, USA
| | | | - Jessie P. Buckley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephanie M. Engel
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tamarra James-Todd
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ami R. Zota
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Emily S. Barrett
- Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | | | - Nicole R. Bush
- University of California, San Francisco, San Francisco, California, USA
| | | | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | | | | | - Sheela Sathyanarayana
- Seattle Children’s Research Institute, University of Washington, Seattle, Washington, USA
| | - Shanna H. Swan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jenny Aalborg
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Donna D. Baird
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | - Asa Bradman
- University of California, Merced, Merced, California, USA
| | | | - Antonia M. Calafat
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Kate E. Christenbury
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Pam Factor-Litvak
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kim G. Harley
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | - Russ Hauser
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Julie B. Herbstman
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Nina Holland
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | - Anne Marie Z. Jukic
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | - John D. Meeker
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen Messerlian
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Karin B. Michels
- University of California, Los Angeles, Los Angeles, California, USA
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Roger B. Newman
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ruby H.N. Nguyen
- University of Minnesota, School of Public Health, Minneapolis, Minnesota, USA
| | - Katie M. O’Brien
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Virginia A. Rauh
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Bruce Redmon
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - David Q. Rich
- University of Rochester Medical Center, Rochester, New York, USA
| | - Emma M. Rosen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Anne P. Starling
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christina Wang
- The Lundquist Institute at Harbor, UCLA Medical Center, West Carson, California, USA
| | - Deborah J. Watkins
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Clarice R. Weinberg
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Barry Weinberger
- Cohen Children’s Medical Center of New York, Northwell Health, Queens, New York, USA
| | - Abby G. Wenzel
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allen J. Wilcox
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Kimberly Yolton
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yu Zhang
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kelly K. Ferguson
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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Wadden TA, Chao AM, Anderson H, Annis K, Atkinson K, Bolin P, Brantley P, Clark JM, Coday M, Dutton G, Foreyt JP, Gregg EW, Hazuda HP, Hill JO, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Korytkowski M, Lewis CE, Laferrère B, Middelbeek RJ, Munshi MN, Nathan DM, Neiberg RH, Pilla SJ, Peters A, Pi-Sunyer X, Rejeski JW, Redmon B, Stewart T, Vaughan E, Wagenknecht LE, Walkup MP, Wing RR, Wyatt H, Yanovski SZ, Zhang P. Changes in mood and health-related quality of life in Look AHEAD 6 years after termination of the lifestyle intervention. Obesity (Silver Spring) 2021; 29:1294-1308. [PMID: 34258889 PMCID: PMC8903054 DOI: 10.1002/oby.23191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The Action for Health in Diabetes (Look AHEAD) study previously reported that intensive lifestyle intervention (ILI) reduced incident depressive symptoms and improved health-related quality of life (HRQOL) over nearly 10 years of intervention compared with a control group (the diabetes support and education group [DSE]) in participants with type 2 diabetes and overweight or obesity. The present study compared incident depressive symptoms and changes in HRQOL in these groups for an additional 6 years following termination of the ILI in September 2012. METHODS A total of 1,945 ILI participants and 1,900 DSE participants completed at least one of four planned postintervention assessments at which weight, mood (via the Patient Health Questionnaire-9), antidepressant medication use, and HRQOL (via the Medical Outcomes Scale, Short Form-36) were measured. RESULTS ILI participants and DSE participants lost 3.1 (0.3) and 3.8 (0.3) kg [represented as mean (SE); p = 0.10], respectively, during the 6-year postintervention follow-up. No significant differences were observed between groups during this time in incident mild or greater symptoms of depression, antidepressant medication use, or in changes on the physical component summary or mental component summary scores of the Short Form-36. In both groups, mental component summary scores were higher than physical component summary scores. CONCLUSIONS Prior participation in the ILI, compared with the DSE group, did not appear to improve subsequent mood or HRQOL during 6 years of postintervention follow-up.
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Affiliation(s)
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ariana M. Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Harelda Anderson
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | - Kirsten Annis
- Department of Psychiatry, Alpert Medical School at Brown University, The Miriam Hospital, Providence, RI, USA
| | - Karen Atkinson
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Paula Bolin
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | | | - Jeanne M. Clark
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gareth Dutton
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - John P. Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Edward W. Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Helen P. Hazuda
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James O. Hill
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Van S. Hubbard
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - John M. Jakicic
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Karen C. Johnson
- Departments of Preventitive Medicine and Psychiatry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - William C. Knowler
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Disease, Phoenix, Arizona and Shiprock, NM, USA
| | - Mary Korytkowski
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Blandine Laferrère
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - David M. Nathan
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca H. Neiberg
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Scott J. Pilla
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Peters
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jack W. Rejeski
- Department of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Bruce Redmon
- Department of Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, MN, USA
| | | | | | - Lynne E. Wagenknecht
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael P. Walkup
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Rena R. Wing
- Department of Psychiatry, Alpert Medical School at Brown University, The Miriam Hospital, Providence, RI, USA
| | - Holly Wyatt
- Department of Medicine, School of Medicine,University of Colorado Denver - Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Z. Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Ping Zhang
- Centers for Disease Control and Prevention, DDT Health Economics Workgroup Atlanta, GA, USA
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3
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Zhang P, Atkinson KM, Bray GA, Chen H, Clark JM, Coday M, Dutton GR, Egan C, Espeland MA, Evans M, Foreyt JP, Greenway FL, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Huckfeldt PJ, Jackson SD, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Knowler WC, Korytkowski M, Lewis CE, Maruthur NM, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Rushing JT, Steinburg H, Wadden TA, Wing RR, Wyatt H, Yanovski SZ. Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study. Diabetes Care 2021; 44:67-74. [PMID: 33168654 PMCID: PMC7783933 DOI: 10.2337/dc20-0358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. RESULTS Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. CONCLUSIONS Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.
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Affiliation(s)
- Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen M Atkinson
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mace Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Caitlin Egan
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, U.K
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James O Hill
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Van S Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Peter J Huckfeldt
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Robert W Jeffery
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Tina Killean
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Nisa M Maruthur
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David M Nathan
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Anne Peters
- Houston Methodist Research Institute, Baylor College of Medicine, Houston, TX
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY
| | - Henry Pownall
- Division of Endocrinology and Diabetes, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Redmon
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Julia T Rushing
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Helmut Steinburg
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia, PA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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4
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Chao AM, Wadden TA, Berkowitz RI, Blackburn G, Bolin P, Clark JM, Coday M, Curtis JM, Delahanty LM, Dutton GR, Evans M, Ewing LJ, Foreyt JP, Gay LJ, Gregg EW, Hazuda HP, Hill JO, Horton ES, Houston DK, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Kure A, Michalski KL, Montez MG, Neiberg RH, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Redmon B, Rejeski WJ, Steinburg H, Walker M, Williamson DA, Wing RR, Wyatt H, Yanovski SZ, Zhang P. Weight Change 2 Years After Termination of the Intensive Lifestyle Intervention in the Look AHEAD Study. Obesity (Silver Spring) 2020; 28:893-901. [PMID: 32320144 PMCID: PMC7437140 DOI: 10.1002/oby.22769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study evaluated weight changes after cessation of the 10-year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2-year observational period following termination of weight-loss-maintenance counseling than would participants in the diabetes support and education (DSE) control group. METHODS Look AHEAD was a randomized controlled trial that compared the effects of ILI and DSE on cardiovascular morbidity and mortality in participants with overweight/obesity and type 2 diabetes. Look AHEAD was converted to an observational study in September 2012. RESULTS Two years after the end of the intervention (EOI), ILI and DSE participants lost a mean (SE) of 1.2 (0.2) kg and 1.8 (0.2) kg, respectively (P = 0.003). In addition, 31% of ILI and 23.9% of DSE participants gained ≥ 2% (P < 0.001) of EOI weight, whereas 36.3% and 45.9% of the respective groups lost ≥ 2% of EOI weight (P = 0.001). Two years after the EOI, ILI participants reported greater use of weight-control behaviors than DSE participants. CONCLUSIONS Both groups lost weight during the 2-year follow-up period, but more ILI than DSE participants gained ≥ 2% of EOI weight. Further understanding is needed of factors that affected long-term weight change in both groups.
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Affiliation(s)
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert I Berkowitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Blackburn
- Division of Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Paula Bolin
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffrey M Curtis
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Evans
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Linda J Ewing
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Linda J Gay
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen P Hazuda
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James O Hill
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward S Horton
- Department of Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Denise K Houston
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - John M Jakicic
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - William C Knowler
- Southwestern American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases and St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anne Kure
- Division of Metabolism, Endocrinology and Nutrition, US Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | - Katherine L Michalski
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria G Montez
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rebecca H Neiberg
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jennifer Patricio
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Anne Peters
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University, New York, New York, USA
| | - Henry Pownall
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Reboussin
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Bruce Redmon
- Divisions of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Jack Rejeski
- Department of Internal Medicine - Geriatrics, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Helmut Steinburg
- Departments of Preventive Medicine and Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martha Walker
- Division of Endocrinology, University of Southern California, Los Angeles, California, USA
| | | | - Rena R Wing
- Department of Psychiatry, The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Holly Wyatt
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gregg E, Jakicic J, Blackburn G, Bloomquist P, Bray G, Clark J, Coday M, Curtis J, Egan C, Evans M, Foreyt J, Foster G, Hazuda H, Hill J, Horton E, Hubbard V, Jeffery R, Johnson K, Kitabchi A, Knowler W, Kriska A, Lang W, Lewis C, Montez M, Nathan D, Neiberg R, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Regensteiner J, Rejeski J, Ribisl P, Safford M, Stewart K, Trence D, Wadden T, Wing R, Yanovski S. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4:913-921. [PMID: 27595918 PMCID: PMC5094846 DOI: 10.1016/s2213-8587(16)30162-0] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Findings from the Look AHEAD trial showed no significant reductions in the primary outcome of cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention for weight loss compared with those randomly assigned to diabetes support and education (control). We examined whether the incidence of cardiovascular disease in Look AHEAD varied by changes in weight or fitness. METHODS Look AHEAD was a randomised clinical trial done at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76 years with type 2 diabetes were assigned (1:1) to an intensive lifestyle intervention or diabetes support and education. In this observational, post-hoc analysis, we examined the association of magnitude of weight loss and fitness change over the first year with incidence of cardiovascular disease. The primary outcome of the trial and of this analysis was a composite of death from cardiovascular causes, non-fatal acute myocardial infarction, non-fatal stroke, or admission to hospital for angina. The secondary outcome included the same indices plus coronary artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalisation for congestive heart failure, peripheral vascular disease, or total mortality. We adjusted analyses for baseline differences in weight or fitness, demographic characteristics, and risk factors for cardiovascular disease. The Look AHEAD trial is registered with ClinicalTrials.gov, number NCT00017953. FINDINGS For the analyses related to weight change, we excluded 311 ineligible participants, leaving a population of 4834; for the analyses related to fitness change, we excluded 739 participants, leaving a population of 4406. In analyses of the full cohort (ie, combining both study groups), over a median 10·2 years of follow-up (IQR 9·5-10·7), individuals who lost at least 10% of their bodyweight in the first year of the study had a 21% lower risk of the primary outcome (adjusted hazard ratio [HR] 0·79, 95% CI 0·64-0·98; p=0·034) and a 24% reduced risk of the secondary outcome (adjusted HR 0·76, 95% CI 0·63-0·91; p=0·003) compared with individuals with stable weight or weight gain. Achieving an increase of at least 2 metabolic equivalents in fitness change was associated with a significant reduction in the secondary outcome (adjusted HR 0·77, 95% CI 0·61-0·96; p=0·023) but not the primary outcome (adjusted HR 0·78, 0·60-1·03; p=0·079). In analyses treating the control group as the reference group, participants in the intensive lifestyle intervention group who lost at least 10% of their bodyweight had a 20% lower risk of the primary outcome (adjusted HR 0·80, 95% CI 0·65-0·99; p=0·039), and a 21% lower risk of the secondary outcome (adjusted HR 0·79, 95% CI 0·66-0·95; p=0·011); however, change in fitness was not significantly associated with a change in the primary outcome. INTERPRETATION The results of this post-hoc analysis of Look AHEAD suggest an association between the magnitude of weight loss and incidence of cardiovascular disease in people with type 2 diabetes. These findings suggest a need to continue to refine approaches to identify individuals who are most likely to benefit from lifestyle interventions and to develop strategies to improve the magnitude of sustained weight loss with lifestyle interventions. FUNDING US National Institute of Diabetes and Digestive and Kidney Diseases.
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Sathyanarayana S, Grady R, Barrett ES, Redmon B, Nguyen RHN, Barthold JS, Bush NR, Swan SH. First trimester phthalate exposure and male newborn genital anomalies. Environ Res 2016; 151:777-782. [PMID: 27567446 DOI: 10.1016/j.envres.2016.07.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Anti-androgenic phthalates are environmental chemicals that affect male genital development in rodents leading to genitourinary birth defects. We examined whether first trimester phthalate exposure may exert similar effects in humans leading to an increased incidence of newborn male genital anomalies in a multi-center cohort study. METHODS We recruited first trimester pregnant women within The Infant Development and the Environment Study (TIDES) from 2010 to 2012 from four study centers and limited analyses to all mother/male infant dyads who had complete urinary phthalate and birth exam data (N=371). We used multivariate logistic regression to determine the odds of having a genital anomaly in relation to phthalate exposure. RESULTS Hydrocele was the primary abnormality observed in the cohort (N=30) followed by undescended testes (N=5) and hypospadias (N=3). We observed a statistically significant 2.5 fold increased risk (95% CI 1.1, 5.9) of having any anomaly and 3.0 fold increased risk (95% CI 1.2, 7.6) of isolated hydrocele in relation to a one log unit increase in the sum of di-ethylhexyl phthalate (DEHP) metabolites. CONCLUSIONS First trimester urinary DEHP metabolite concentrations were associated with increased odds of any newborn genital anomaly, and this association was primarily driven by isolated hydrocele which made up the majority of anomalies in newborn males. The association with hydrocele has not been previously reported and suggests that it may be an endpoint affected by prenatal phthalate exposures in the first trimester of development. Future human studies should include hydrocele assessment in order to confirm findings.
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Affiliation(s)
- Sheela Sathyanarayana
- Seattle Children's Research Institute, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Richard Grady
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Emily S Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Bruce Redmon
- Department of Endocrinology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ruby H N Nguyen
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Julia S Barthold
- Division of Urology, Department of Surgery, Nemours/Alfred I DuPont Hospital for Children, DE, USA
| | - Nicole R Bush
- Departments of Psychiatry and Pediatrics, University of California, San Francisco, USA
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai , New York City, NY, USA
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Serrano SE, Karr CJ, Seixas NS, Nguyen RHN, Barrett ES, Janssen S, Redmon B, Swan SH, Sathyanarayana S. Dietary phthalate exposure in pregnant women and the impact of consumer practices. Int J Environ Res Public Health 2014; 11:6193-215. [PMID: 24927036 PMCID: PMC4078574 DOI: 10.3390/ijerph110606193] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
Abstract
Phthalates are ubiquitous endocrine-disrupting chemicals that are contaminants in food and contribute to significant dietary exposures. We examined associations between reported consumption of specific foods and beverages and first trimester urinary phthalate metabolite concentrations in 656 pregnant women within a multicenter cohort study, The Infant Development and Environment Study (TIDES), using multivariate regression analysis. We also examined whether reported use of ecofriendly and chemical-free products was associated with lower phthalate biomarker levels in comparison to not following such practices. Consumption of one additional serving of dairy per week was associated with decreases of 1% in the sum of di-2-ethylhexyl phthalate (DEHP) metabolite levels (95% CI: -2.0, -0.2). Further, participants who reported sometimes eating homegrown food had monoisobutyl phthalate (MiBP) levels that were 16.6% lower (95% CI: -29.5, -1.3) in comparison to participants in the rarely/never category. In contrast to rarely/never eating frozen fruits and vegetables, participants who reported sometimes following this practice had monobenzyl phthalate (MBzP) levels that were 21% higher (95% CI: 3.3, 41.7) than rarely/ever respondents. Future study on prenatal dietary phthalate exposure and the role of consumer product choices in reducing such exposure is needed.
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Affiliation(s)
- Samantha E Serrano
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA 98121, USA.
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Noah S Seixas
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Ruby H N Nguyen
- Department of Epidemiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Emily S Barrett
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14623, USA.
| | - Sarah Janssen
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
| | - Bruce Redmon
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Sheela Sathyanarayana
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA 98121, USA.
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8
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Jensen TK, Swan S, Jørgensen N, Toppari J, Redmon B, Punab M, Drobnis EZ, Haugen TB, Zilaitiene B, Sparks AE, Irvine DS, Wang C, Jouannet P, Brazil C, Paasch U, Salzbrunn A, Skakkebæk NE, Andersson AM. Alcohol and male reproductive health: a cross-sectional study of 8344 healthy men from Europe and the USA. Hum Reprod 2014; 29:1801-9. [PMID: 24893607 DOI: 10.1093/humrep/deu118] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Is there an association between alcohol intake and semen quality and serum reproductive hormones among healthy men from the USA and Europe? SUMMARY ANSWER Moderate alcohol intake is not adversely associated with semen quality in healthy men, whereas it was associated with higher serum testosterone levels. WHAT IS KNOWN ALREADY High alcohol intake has been associated with a wide range of diseases. However, few studies have examined the correlation between alcohol and reproductive function and most have been conducted in selected populations of infertile men or have a small sample size and the results have been contradictory. STUDY DESIGN, SIZE, DURATION A coordinated international cross-sectional study among 8344 healthy men. A total of 1872 fertile men aged 18-45 years (with pregnant partners) from four European cities and four US states, and 6472 young men (most with unknown fertility) aged 18-28 years from the general population in six European countries were recruited. PARTICIPANTS/MATERIALS, SETTING, METHODS The men were recruited using standardized protocols. A semen analysis was performed and men completed a questionnaire on health and lifestyle, including their intake of beer, wine and liquor during the week prior to their visit. Semen quality (semen volume, sperm concentration, percentage motile and morphologically normal sperm) and serum reproductive hormones (FSH, LH, testosterone, sex hormone-binding globulin, and inhibin B and free testosterone) were examined. MAIN RESULTS AND THE ROLE OF CHANCE The participation rate for our populations was 20-30%. We found no consistent association between any semen variable and alcohol consumption, which was low/moderate in this group (median weekly intake 8 units), either for total consumption or consumption by type of alcohol. However, we found a linear association between total alcohol consumption and total or free testosterone in both groups of men. Young and fertile men who consumed >20 units of alcohol per week had, respectively, 24.6 pmol/l (95% confidence interval 16.3-32.9) and 19.7 pmol/l (7.1-32.2) higher free testosterone than men with a weekly intake between 1 and 10 units. Alcohol intake was not significantly associated with serum inhibin B, FSH or LH levels in either group of men. The study is the largest of its kind and has sufficient power to detect changes in semen quality and reproductive hormones. LIMITATIONS, REASONS FOR CAUTION The participation rate was low, but higher than in most previous semen quality studies. In addition, the study was cross-sectional and the men were asked to recall their alcohol intake in the previous week, which was used as a marker of intake up to 3 months before. If consumption in that week differed from the typical weekly intake and the intake 3 months earlier, misclassification of exposure may have occurred. However, the men were unaware of their semen quality when they responded to the questions about alcohol intake. Furthermore, we cannot exclude that our findings are due to unmeasured confounders, including diet, exercise, stress, occupation and risk-taking behavior. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that moderate alcohol intake is not adversely associated with semen quality in healthy men, whereas it was associated with higher serum testosterone levels which may be due to a changed metabolism of testosterone in the liver. Healthy men may therefore be advised that occasional moderate alcohol intake may not harm their reproductive health; we cannot address the risk of high alcohol consumption of longer duration or binge drinking on semen quality and male reproductive hormones. STUDY FUNDING/COMPETING INTERESTS All funding sources were non-profitable and sponsors of this study played no role in the study design, in data collection, analysis, or interpretation, or in the writing of the article. The authors have no conflicts of interest.
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Affiliation(s)
- Tina Kold Jensen
- Department of Environmental Epidemiology, University of Southern Denmark, Winsløwsparken 17, Odense, Denmark Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Shanna Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Niels Jørgensen
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | | | - Bruce Redmon
- Department of Medicine and Urologic Surgery, University Of Minnesota, Minneapolis, MN, USA
| | - Margus Punab
- Department of Andrology Unit, Tartu University Clinicum, Tartu, Estonia
| | - Erma Z Drobnis
- Department of Obstetrics, Gynecology and Women's Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Trine Berit Haugen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Birute Zilaitiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Amy E Sparks
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA
| | - D Stewart Irvine
- Medical Directorate, NHS Education for Scotland, Edinburgh, UK Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christina Wang
- Clinical and Translational Research Center, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Pierre Jouannet
- Biologie de la Reproduction, Hopital Cochin - Universite Paris V, Paris, France
| | - Charlene Brazil
- Department of Obstetrics and Gynecology, University of California, Davis, CA, USA
| | - Uwe Paasch
- Department of Dermatology/Andrology Unit, University of Leipzig, Leipzig, Germany
| | - Andrea Salzbrunn
- Department of Andrology, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Erik Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna-Maria Andersson
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
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Abstract
Despite the successes of Viagra, the quest for new and better therapy for erectile dysfunction (ED) continues. In a recent survey of the first 220 patients placed on Viagra at our institution, 101 (46%) quit taking the drug: 76% of those who quit were not satisfied with the results. Patients clearly want an efficacious, safe, convenient medication with rapid onset. To meet these consumer demands, numerous new therapies are being developed. These include new oral medications, new intracavernosal pharmacotherapies, new delivery systems (such as novel intracorporal injectors and transdermal agents) and combination therapies. What is known about these new medications and delivery systems will be presented. Hopefully, from these innovations will come therapies that will improve the overall success and acceptance of treatment for ED. Since it is unlikely that any single agent will ever provide a solution for all men with ED, an expanded armamentarium of treatment options will greatly enhance the chances that any given man will be able to find a therapy that is both acceptable and appropriate to him. International Journal of Impotence Research (2000) 12, Suppl 4, S158-S162.
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Affiliation(s)
- J L Pryor
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Redmon B, Raatz S, Bantle JP. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337:1773-4; author reply 1775. [PMID: 9411249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
There has been a recent explosion of articles in the medical literature and newsbites on television and in the lay press regarding male menopause. Yet, many men are not familiar with the changes in sexuality that accompany aging. Primary care physicians therefore need to be well informed about the concept of male menopause and the dos, don'ts, and unknowns of treating it with testosterone.
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Affiliation(s)
- D A Schow
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Affiliation(s)
- B Redmon
- Section of Endocrinology, Minneapolis Veterans Affairs Medical Center, MN
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Abstract
The medical records of 486 patients with pathologically proved squamous carcinoma of the skin of the external ear were analyzed. It is a disease of elderly white men, and the helix is the most common site of origin. Well-differentiated squamous carcinoma is the most frequent histologic variant. Ninety-five percent of our patients were treated surgically with above-clavical control in 87 percent and 28 percent survival. The low survival rate was related to the old age of the patients who frequently died of intercurrent disease and second cancers. A 12 percent incidence of nodal metastases is comparable with the incidence reported in other series. Aggressive surgical ablation and the selected use of adjunctive postoperative irradiation appear justified in those patients with locally invasive tumors, multiple nodal metastases, and extracapsular invasion.
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